Provider Demographics
NPI:1922304518
Name:ARYA, BHARAT (PT)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:
Last Name:ARYA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BROCKLY
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:28301 FRANKLIN RD
Mailing Address - Street 2:STE 325
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1672
Mailing Address - Country:US
Mailing Address - Phone:248-208-6100
Mailing Address - Fax:248-209-6119
Practice Address - Street 1:28301 FRANKLIN RD
Practice Address - Street 2:STE 325
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1672
Practice Address - Country:US
Practice Address - Phone:248-208-6100
Practice Address - Fax:248-209-6119
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist